Tobacco
The American Cancer Society reports that tobacco use is the most preventable cause of death in our society, accounting for at least 30% of all cancer deaths. Use of tobacco is responsible for as many as 87% of all lung cancers. There is ample evidence that secondhand smoke, smokeless tobacco, pipe tobacco, cigars, and cigarettes cause cancer. Exposure to secondhand smoke also causes other health problems such as respiratory illness and asthma attacks. Oral cancer occurs several times more frequently among smokeless tobacco users than non-users.
According to the most recent data from the Nebraska Behavioral Risk Factor Surveillance
System (BRFSS), the prevalence of cigarette smoking among Nebraska adults has decreased from 21.2% of the adult population in 2000 to 16.7% in 2009. Nebraska youth who smoked on one or more of the past 30 days in 2001 was 30.5% compared to 18.4% in 2009. Data from the 2008 Nebraska Behavioral Risk Factor Surveillance System (BRFSS) suggests that Nebraska males (20.1%) are more likely to smoke than females (16.7%). Younger adults (ages 18-24) exhibit the highest smoking rates (27.6%) with the lowest being among the 65+ age group (7.7%). The sharp decline in the smoking rate after age 65 may be due to increased mortality attributable to smoking-related diseases. BRFSS fact sheets are included in the Appendix. More specific and timely information is available from the Tobacco Free Nebraska Program’s website at http://www.
dhhs.ne.gov/tfn/tfnpubrep.htm Nutrition and Physical Activity
Diet, obesity, and physical activity are also important modifiable determinants of cancer risk. The American diet is estimated to account for about one-third of all U.S. cancer deaths. The greatest concern with the American diet today is the consumption of too much saturated fat and too few vegetables, fruits, and whole grains. In Nebraska, less than one in four adults who participated in the 2010 BRFSS reported that they consumed recommended servings of fruits and vegetables per day; this was slightly more than the one in five who reported this consumption level in the 1990 survey. The statistics for youth are similarly disappointing. According to the 2001 Nebraska YRBS, only 18% of the state’s high school students reported that they had eaten at least five servings of fruits and vegetables per day during the past seven days.
Obesity is known to increase the risk of developing cancers of the breast among post-menopausal women, cervix, endometrium, ovary, and gall bladder among women, cancer of the colon among
in recommended leisure-time physical activity during the past month; this percentage has been decreasing in recent years. The 2001 Nebraska YRBS shows that one-fourth of youth surveyed had not participated in moderate or vigorous physical activity during the past seven days, fewer than half attended any physical education classes and more than half watched two or more hours of television on an average school day.
The Nebraska Comprehensive Cancer Control Program is working closely with the Nutrition and Activity for Health (NAFH) Program in the Nebraska Department of Health and Human Services to identify opportunities for collaboration. See the BRFSS Data Fact Sheets in the Appendix. More comprehensive and current information is available on the NAFH website:
http://www.dhhs.ne.gov/NAFH/
Cancer Screening
Screening tests are currently available for detecting breast, cervical, colon and rectal cancers. The research arena is working hard to improve these screening modalities and to develop new ones, especially for lung and bronchus cancers.
Breast Cancer
During the decade of the 1990s, breast cancer mortality began to decline substantially in
Nebraska and the nation; this is due in part to the increased use of screening mammography and state level policies supporting treatment after diagnosis of breast cancer. The 2008 BRFSS Fact Sheet notes that approximately 1 in 4 women ages 40+ reported not having a mammogram in the past two years, as seen in the chart below.
Percentage of Nebraska Women 40+ Who Have Had a Mammogram in Past Two Years, 1990-2010
0
Women with some college reported a higher frequency (76.5%) of having a mammogram in the past two years than women with no high school diploma or GED (54.5%). There is some
framework and work plan for the next five years and is integrated into this Nebraska Cancer Plan.
Cervical Cancer
Throughout the United States, cervical cancer incidence and mortality have fallen drastically during the past several decades, as a result of the introduction and widespread adoption of the Pap test as a means to screen for the disease. The Pap test is a simple procedure that can detect cervical cancer and pre-cancerous lesions, and can be performed by a health care professional as part of a pelvic exam.
The results from the 2008 Nebraska BRFSS show that only about 1 in 5 Nebraska women ages 18+ reported not having a Pap test in the past 3 years. Women with more income and with more education were more likely to have had a pap test in the past three years.
Colorectal Cancer
In 2008, colorectal cancer was the fourth most frequently diagnosed cancer among Nebraska residents, accounting for over 1,001 new cases. It was the second leading cause of cancer death in the state. The 2009 BRFSS Fact Sheet indicates that the screening rate for Nebraska adults age 50+ who reported ever having a sigmoidoscopy or colonoscopy increased from 38% in 2001 to 60.1% in 2009. Nebraska also has narrowed the gap between national screening rates and Nebraska rates. Significant progress was made in screening for colorectal cancer during the 2005-2010 plan implementation phase as indicated by the increased screening rates, the development and funding of a Nebraska Colon Cancer Screening Program, the Stay in the Game Campaign, Rollin’ to Colon, Boxer 500 and other activities.
Prostate Cancer
Prostate cancer screening remains controversial. The U.S. Preventive Services Task Force recently concluded again that there is insufficient evidence to promote routine screening for all men and inconclusive evidence that screening improves health outcomes. Two screening tests are commonly used: prostate-specific antigen (PSA) test and digital rectal exam (DRE).
The next section of this plan presents the priorities, goals, objectives and activities for the next plan period, e.g. 2011-2016. These priorities match the nation cancer prevention and control priorities. Annually, a specific work plan and evaluation plan will be developed and distributed to the partnership. As in the past, the plan should be considered to be flexible to meet the evolving needs of the partners and to be adopted to current issues, trends and developments.